Twenty experts in field give Bush administration an overall grade of D+.

All but a few U.S. states are ill-prepared to distribute federally stockpiled drugs and to test human samples for chemical agents in the event of a terrorist attack, a public-health advocacy group said today in an annual readiness report.

After studying federal data, interviewing officials and surveying hospital personnel, the Trust for America's Health said most states possessed no more than half of the benchmark preparedness capabilities that formed the basis for the study.

Twenty-nine states and the District of Columbia achieved 5 or fewer of the 10 benchmarks.

"While considerable progress has been achieved in improving America's health-emergency preparedness, the nation is still not adequately prepared for the range of serious threats we face," the organization said in the report.

On the positive side, seven criteria were more often achieved than not. They included sufficient laboratory capabilities for bioterrorism response, displayed by 37 states; enough laboratory scientists to conduct anthrax or plague tests in an outbreak, achieved by 41 states and the District of Columbia; adequate planning for vaccine- and antiviral-distribution priority-setting in a crisis, found present in 34 states and the District of Columbia; and sufficient medical-supply reserves, achieved by 29 states and the district.

Twenty-seven states were deemed to have adequate disease-tracking systems; 35 were called well-prepared for responding to patient surges by distributing some patients to non-health care facilities; and 35 states and the District of Columbia were found to have adequately quick access to expert infection-control consultation in an emergency.

Despite the relative success of these measures, the study found that three of the benchmarks were reached by only a small number of states. Just seven states had been certified to distribute Strategic National Stockpile drugs; 10 were found to have sufficient chemical terrorism-response capabilities, particularly as pertains to human-sample testing; and only two had sufficient plans for inducing health-care personnel to come to work in a crisis.

Joining Virginia with scores of 8, the highest score recorded, were Delaware and South Carolina. Scoring lowest, at 2, were Alabama, Alaska, Iowa and New Hampshire.

The Association of State and Territorial Health Officials today expressed appreciation for the study. The association emphasized preparedness progress made since 2001, saying federal funds will be crucial for continued gains.

"An increase in resources over the past four years has helped state public-health agencies begin to remedy the damage" from previous "decades of neglect," said association President Leah Devlin said in a statement today, "but public-health preparedness - whether for a bioterrorism event, a pandemic or any other public-health emergency - requires a sustained federal commitment, coupled with continued work, funding, testing and oversight at state and local levels."

The study also addressed federal readiness, surveying 20 experts in the field who gave the Bush administration an overall grade of D+ for "public-health and bioterrorism-preparedness performance." The administration performed worst in the area of smallpox vaccination, receiving a grade of D-, and received its highest grade, a C, for its handling of last year's influenza-vaccine shortage.

The Trust for America's Health called for stronger central leadership and clearer accountability in public health, particularly at the Health and Human Services Department and its Centers for Disease Control and Prevention. It said the government should also improve basic response capabilities, boost funding and work more with the public and press to prepare for public-health emergencies.